NHS targets disrupt war against superbugs

Nurses are warning that their attempts to rid hospitals of superbugs such as MRSA are being undermined by managers and doctors under pressure to treat as many patients as possible to meet waiting list targets.

The growing rates of hospital-acquired infections have led Health Secretary John Reid to call for a new drive to clean up hospital wards, and to call in foreign experts to advise the NHS.

But the move has angered nurses at the forefront of trying to curb rising rates of infection. They say that they have evidence that some chief executives have prevented them from closing infected wards because of the effect on targets. If hospitals fail to meet targets, their performance-related ratings can slide and that in turn can lose them up to £2 million a year.

The Infection Control Nurses' Association, which represents nurses across England responsible for bringing in measures to curb superbugs, say they are often ignored or that their advice is given lip service by managers and policy-makers. They have so far been denied the chance to meet Reid to discuss the issue.

There is some support for their claim from the National Audit Office, the parliamentary spending watchdog whose authoritative report last week showed that one in eight infection control teams had had decisions to close a ward 'questioned or overruled' by chief executives.

'We are very worried that our attempts to prevent outbreaks are being thwarted, for various reasons,' said Christine Perry, chair of the association. 'Some hospitals are far better than others at supporting the work, but generally it is not given the priority it needs.'

Perry, a senior nurse at the Bristol Royal Infirmary, added: 'We can, for example, be overruled when we want to close a ward, possibly because there is an outbreak of a diarrhoea or a vomiting illness, or flu. I personally have had that experience. It could be for clinical reasons, but it could also be because of the waiting list pressures.'

She said that nurses were also under constant pressure to save money, by economising on hand gel that can kill bacteria, or by using cheaper handtowels which discourage staff from washing their hands frequently.

'I don't know why John Reid is talking about bringing in experts from abroad when the experts that he has right here in the UK are not being listened to,' she said. 'For example, there needs to be mandatory training on infection control for all staff, and that has to include senior medical consultants, but that isn't happening.'

Nurses say it can be difficult to move a patient with MRSA (methicillin-resistant staphylococcus aureus) into an isolation room away from other patients, because the bed is needed for a patient who is far more seriously ill.

The association believes that staff have been told to implement initiatives on MRSA without the authority or the resources to bring about the changes that would stem the crisis.

The same point was made last week by Sir John Bourn, the comptroller and auditor-general, who wrote the NAO report. 'I am concerned that the NHS still does not have a proper grasp of the extent and cause of hospital-acquired infections,' he said.

The number of reported cases of people harbouring the staphylococcus aureus bacteria has risen from 17,000 to 19,300 in three years. The number of deaths from the antibiotic-resistant form of the bug is not clear, but could range between 800 and 5,000 a year.

The Department of Health emphasised that it was working with the association to develop a checklist for nurses on issues such as hand hygiene and decontamination of equipment.

But there is growing concern that the pace of NHS reforms has made it far harder to maintain the hygiene procedures. One government target is that no one should wait for more than four hours in an accident and emergency unit, which has resulted in far more people being admitted to wards when they need to be assessed.

Lib Dem health spokesman Paul Burstow said: 'Government targets are making matters worse by forcing hospital managers to keep all beds full. This stops proper cleaning from taking place and means that infected patients could be shunted around from ward to ward.'